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Dr. Howard Michaels - Insurance CertificateCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD1YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 408- 241 -0014 CT Rhonda Buck nsPro Agents & Brokers Ins. PHONE 408- 241 -0014 FAAX 408 -241 -0037 Llcense #01318019 (AIC, No, Ext): (A1C, No): 1.020 Moorpark Avenue, #104 MASS: San Jose, CA 95117 nspro Agents &Brokers Ins Sery INSURER(S) AFFORDING COARAQE NAIC A _ INSURER A, Sentinel Insurance Co Ltd INSURED Howard Michaels, M.D. INSURERS: 5875 Killarney Cir INSURER C: San Jose, CA 95138 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LT TYPE OF INSURANCE ADDL IN $D SUER! WVD POLICY NUMBER POLICY EFF 1 1DD YY YYI POLICY EXP JMM1DDlyYYYL LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS�MADE a OCCUR I57SBANL5390 _ 07!0212017 07/02/2018 EACH OCCURRENCE 2,000,00 6AMAGE TO RENTED PREMISES $ $00 00 -D EX10 v one arson $ 10,00 X Hired NOA PERSONAL & ADV INJURY 2,000,00 GENT AGGREGATE LIMIT APPLIES PER POLICY ❑ wf FI LOC OTHER: GENERAL AGGREGATE $ 4,000,00 PRODUCTS- M I P G 4,000,00 AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS yy Ep AUTOS ONLY AUTOS OMIY CE.. 1d'e tSINGLE LIMIT $ 9 YL INJURY IPer eon BODILY INJURY Per occident S TOPER 'cRj �r RMAGE Is UMBRELLA UAB EXCESS LIAR OCCUR EACH OCCURRENCE HCLAIMS-MADE AGGREGATE $ DEEED RNNE1- ENT10H $ $ ANDEMpLOYERS LIA TION Y1N ANY PROPRIETORIPARTNER/EXECUTIVE ❑ pF nC�OIryEMCR EXCLUDED? (M H) IE Xe desuibo undar DESCs, RIPTION OF OPERATIONS below NIA PTR OTH- E.L. EACH ACCIDENT $ E l DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ i I 1 8My,p SCRIPT, �1 OF OP Ti�pp�3 ! LOCAT�Qp glYE�{NCLES (AG RD 1 Adtlltlonal Rem gr,Schad le, maybe attached ff more space Is required) of [a°Ilroy, itf s UTrlcerS, U ITiiclals, anQ t°mp%yees are ad'gI IonaY Insured as required bywrltten contractwith respectto operations of the named Insured perform SS00090405 attached. City of Gilroy Gilroy Fire Department 7070 Chestnut Street Gilroy, CA 95020 ACORD 25 (2016103) CITY -15 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE O 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICYNUMBER :57 SBA NL5390 KIVU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON - ORGANIZATION CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES 7070 CHESTNUT STREET GILROY, CA 95020 Form IH 120011 85 TSEQ. NO. 001 Printed In U.S.A. Page 001 PracessDate; 04/21/17 ExplradonDate; 07/02/16 CERTIFICATE OF LIABILITY INSURANCE 0 7108120 1 9 THIS CE _ATE-DOE 1 MFUED LAS A MATTER R F INFORMATION AMEND. OR ALTER RIGHTS 'fHE COVERAGE AFFORDED ABY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONS. rfUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI2EO REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IRIPORTANT: if the aardtleete holder Is an ADDITIONAL INSURED, the polloy(les) must be endorsed. If BUBROOATION IS WAIVED, eats to to the tams and Cond)None of the policy. Conaln pcildae may require an endorsement. A statement on this cons loato does not 0otdaz Aghte to the aenlDcate holder In Ueu of such endorsement e . Rhomla Buok x104 MODVCOR P ,1409- 241A014 _ C 40&20 0087 sPro '& Brokers Ins. _. �oenso 13110019 - t20 MOOroerk Avenue, #F04 an Jose, CA 95117 PI s APPDRD=M OOVIRA09 _ mnm Ammts &Broken Ins Ssry OR [fl OCCUR Hired.NOA P A ANYAUr0 ALL D SCHWULED AUTO X KIRED: x NOD MiEO UUMASUA UAD OCCUR City of Gilroy Gilroy Fire Department 7070 Chestnut Street Gilroy, CA 95020 ACORD 25 (2014101) , 0710212017 07102@010 1 0710212017 Is Mojredl of the ALL s s CITY -15 I SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 THE EXPIRATION DATE THEREOF, NOTICE MULL BE DELIVERED IN ACCORDANCE WRH THE POLICY PROVISIONS. The ACORD,name and logo are registered marks of ACORD AFRO® CERTIFICATE OF LIABILITY INSURANCE rv1 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 1810912016 THIS CERTIFICATE IS ISSUED, AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD @R THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW., THIS.CERTFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER _ IMPORTANT: If the cortHlcalo holder Is an ADDITIONAL INSURED, thG pollcy'(les) must bo ondorsod. R SUBROGATION 18 WANED, subject to �roquiro tho terms and Conditions of tho pollay, Chain pollelas may an ondoisement A atammom an this oonRloBls does not confer rights to tho aortiDanto holdor In Rau of such ondorsemen e . PRODUCER AONPAfflnity Insurance Services, Inc. BafhaN SlaplflaU DoOOAR Kerekr 159 East County Line Road eaaeto67re Faa "°`�'I` - - - --18 AO., Hatboro, PA 19040ss�._� e9mornBMpf me�ron.mm r . POLILY ; Lfk _iReanaR UJ AMM URO COVeMOS -- _. rl MUMMA, UnCIIEWMMLloyd's Landon INSURED Howard E. Michaels, M.D. Lffill, - 255 S. Montgomery wepMeno__. _I . . San Jaw, CA 95138 WOUNeRDi m omro SCHEDULED -, AVGG , AUTOS .. ... _. • GODRY INJURY abf ewlorlU' 6 NON -OMEO . . MEDAJTOS _ : ALaOS AhOpIR E __ COVERAGES CERTIFICATE NUMBER REV9110M Mr MMnnn. - THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. w _ - TmaoPUOURAnce - . TAMCtM' - - MXYRUMOM _ _ _ - uYRe.._.- . . CONN6AGALOOMMAL ILMIILRY EACN000URRENCE { CU VM344ADE OCCUR I ' TO REN _. . DAMAGE im" . _ - _. .MPG E%P IAltlwop,wm „3 .. -- _ PERSawEeAwlwunv b fiEN1.AGGREGATE UMn APPLIES PER GENERA. AGGREGATE r r . POLILY ; Lfk .. PROGIJOTB•COLR'IOPAGG I J .- rl Is AVTOMOBgBLMONTY Lffill, - ,b '.' -._._. . ANYAUTO B0pLYQUURY"PTN0n1 m omro SCHEDULED -, AVGG , AUTOS .. ... _. • GODRY INJURY abf ewlorlU' 6 NON -OMEO . . MEDAJTOS _ : ALaOS AhOpIR E __ -b — UMaf1ELLAWR jOCCUR 6nCHOCCURREACE L . . aSCeee Me : CLAMS.YADR.. - aGGnaonTa 5 -1 i CED. AsTAWICIN i wololeMS CmwRJalnoN ;1wadIPLOYD18YAeL1TY YIN ' .. 8 A UTE •ANY PaoImlEroamnMrnwaxT.cVrlw IDFr6ERNPYMEflnkCWDEO" FI NIA' i - ei_BACKACCXXNT ;s, lyeoTVOSM NCR , El ORSASSEAEYPLGYEe� b 'N`Y' E L OSEASE • POLICY Lam' i 1,000,000 Par ClelBd Profueslonal Liability N MAH16-0329 i : W0912015 81092017 ' 83,000,000 Annual Aggregate DescmPnaN OPOPCRATxN181 LOLY,TRUYb /VSNICLBB IACORO1eT, 4aUImnM PemorNr eNYIWq,nY IY MMrhW R emm rM� h re9WIM1 Coverage Type: Claims Made Specialty: Medical Director Retroactive Date: 8/09/2005 Gilroy Fire Department 7070 Chestnut St. Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TWO EXPIRATION DATE THEREOF, NOTICE MALL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVIBIONB. Affinity Insurance Services, Inc. n..v,.v AP Nxv,we q r D8 AG V RY mme 8m lagO BIB mglstOrOd MBrRS Of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE 12016 YYYY) o72s2o1s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh USA Inc. 1560 SSaawwoqrass Corporate Pkwy, Suite 300 SundSe,FC 33323 Attl. F( LauderdafECertRequest@malsh.cdm F:212 -94 &0512 CONTACT NAME: PNONE ac No ; 0, Exth ED AIE . 6018302277 0613012016 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Continental Insurance Company 35289 101309 -GAWU- PROF -16 -17 INSURED Corporation/ Advanced Data Processing, Inc. e. American Casualty Company Of Reading, Pa 20427 INSURER C: WA NIA INSURER D PERSONAL a ACV INJURY 6451 North Federal Highway, Suite 1000 Fort Lauderdale, FL 33308 GEWL AGGREGATE LIMIT APPLIES PER (POLICY DIO- JET O'LOC OTHER GENERAL AGGREGATE S 2,000,000 NSURER I.: $ 2,000,000 INSURER F: $ A COVERAGES CERTIFICATE NUMBER: ATL- 003492621 -21 REVISION NUMBER:31 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD - INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR L TYPE OF INSURANCE POLICY NUMBER mmmo POLICY D LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE M OCCUR 6018302277 0613012016 06130%2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES occunance $ 1900,000 MED EXP one on) It 15,000 PERSONAL a ACV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER (POLICY DIO- JET O'LOC OTHER GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 $ A 'AUTOMOBILE LIABILITY ANY AUTO LALL OWNED SCHEDULED ,AUTOS AUTOS NON-OWNED EO HIRED AUTOS 6018302263 0613012016 0613012017 COMBINED SINGLE LIMIT (Eanccllentl $ 1.000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE It $ UMBRELLA LIAS EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ B B WORKERS COMPENSATION- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YN/❑N OFFICERMEMBER EXCLUDE09 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 6018302294 (ADS) 6018302280 (CA) 06/3012016 0613012016 05/3012917 061702017 X PER OTH- TATUTE EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AComonal Remarks Schedule, may W Inched If mom space Is required) The City of Gilroy, Its officers and employees are included as additional insured (except workers' compensation) where mquimd by written contract City of Gilroy Attn: Jennifer Baker Division Chief Gilroy Fire Department 7070 Chestnut Gilroy, CA 95020 ACORD 26 (2014101) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Carmen Gordon `e2� ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD G & 0 INS SERVICES 820 PARK ROW #618 SALINAS, CA 93901 HOWARD E MICHAELS 5875 KILLARNEY CIRCL JAN JOSE, CA 95138 Additional insured endorsement Name of Person or Organization CITY OF GILROY 7351 ROSANNA ST GILROY. CA 95020 PRUMEENIF COMMERC /AL Policy number: 04320437 -7 Underwritten by: United Financial Casualty Company Insured: HOWARD E MICHAELS July 13, 2016 Policy Period Sep 1, 2016 - Sep 1, 2017 Mailing Address United Financial Casualty Company PO Box 94739 Cleveland, OH 44101 1- 800. 4444487 For customer service, 24 hours a day, 7 days a week The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that:insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury Not applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. ... This endorsement applies to Policy Number: 04320437 -7 Issued to (Name of Insured): HOWARD E MICHAELS Effective date of endorsement: 09/01/2016 Policy expiration date: 09/0112017 Form 1198 (01104)